[Analysis of the Adequacy of Nurse Staffing Level through the Estimation of Nursing Activity Hours and Implementation of Focus Group Interviews in a Tertiary Hospital: Using a Mixed-Method Design].

PURPOSE: This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload. METHODS: The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively. RESULTS: The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload. CONCLUSION: These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.

The effects of an emergency department length-of-stay management system on severely ill patients' treatment outcomes.

PURPOSE: This study aimed to compare the length of stay (LOS) and treatment outcomes based on the application and achievement of a newly developed emergency department (ED) LOS management system for severely ill patients. METHODS: Data were retrospectively collected from electronic medical records (EMRs) for the system evaluation and research purpose. The study subjects are severely ill patients whose diagnosis codes are designated by the Ministry of Health and Welfare and who visited the ED of a tertiary hospital from January to December 2019. The control group (Group 1) refers to those who have neither applied nor achieved the goal (5 hours or less) of the ED LOS management system even after it was applied, and the experimental group (Group 2) refers to those who have achieved the 5-hour goal after applying the system. RESULTS: A total of 2034 severely ill patients applied the ED LOS management system. Group 1 included 837 patients and Group 2 included 1197 patients. Thirty days in-hospital mortality corresponded to 10.6% in Group 1 and 6.6% in Group 2 (χ2 = 10.58, p = .001). The total duration of hospitalization was 14.66 ± 18.26 days in Group 1 and 10.19 ± 16.00 days in Group 2 (t = 9.03, p < .001). Six hundred forty-two patients (76.6%) in Group 1 were discharged to their home (normal discharge) and 979 patients (81.7%) were discharged to their home in Group 2, but the discharge-as-death rate was 14.1% in Group 1 and 7.5% in Group 2 (χ2 = 29.80, p < .001). CONCLUSION: With the application and attainment of the ED LOS management system for severely ill patients, we have concluded the new system produced a lower LOS in the ED, 30 days in-hospital mortality, length of the hospitalization, mortality rate, and a higher rate of normal discharge.

Impact of pressure ulcer prevention knowledge and attitude on the care performance of long-term care facility care workers: a cross-sectional multicenter study.

BACKGROUND: The Long-Term Care Insurance Act in the Republic of Korea has enabled the elderly population to receive benefits through the long-term care system since July 2008. Because one nurse or nursing assistant is assigned to 25 elderly persons and one care worker is assigned to 2.5 elderly persons in long-term care facilities, registered nurses should educate care workers to participate in pressure ulcer prevention activities. This descriptive study investigated the effect of the knowledge and attitude related to pressure ulcer prevention on care performance. METHODS: Data were collected from February 20 to December 15, 2021 using a structured questionnaire targeting 165 care workers in four long-term care facilities located in I-city and Y-gun, Gyeongsangbuk-do. The questionnaires of the knowledge, attitude, and care performance developed for nurses were modified to survey the care workers. The content validity was verified on a 4-point scale by 10 clinical experts. A preliminary survey was conducted for 30 care workers, and the contents of the modified questionnaire were further revised. Data analyses were performed by t-test, one-way ANOVA, Scheffé test, Pearson's correlation coefficient, and a multiple linear regression modeling using the SPSS/WIN 25.0 program. RESULTS: Care performance on pressure ulcer prevention had a significant positive correlation with knowledge (r = 0.692, p < .001), attitude (r = 0.426, p < .001), work experience (r = 0.760, p < .001), amount of experience (r = 0.712, p < .001), and the number of training sessions received (r = 0.551, p < .001). In multiple regression modeling, work experience (ß [standardized coefficient beta] = 0.534, p = .000), knowledge (ß = 0.323, p = .000), and attitude (ß = 0.103, p = .049) related to pressure ulcer prevention were identified as variables significantly affecting care performance. The regression model explained 65.4% with 5 independent variables. CONCLUSION: To prevent bedsores in long-term care facilities, it is necessary to educate care workers regularly about pressure ulcer prevention. In addition, clinical guidelines could help standardize the pressure ulcer prevention work of caregivers, strongly regulating their practice in all long-term care facilities and monitoring bedsore prevention regularly.

Development and Validation of a Sexual-Outlook Questionnaire (SOQ) for Adult Populations in the Republic of Korea.

A Sexual Outlook Questionnaire (SOQ) that can apply to a wide range of Korean populations, including disabled people, was necessary for comprehensive research on improving clinical practice of sexual education and developing sex-related intervention programs. We developed the SOQ and tested its validity with exploratory and confirmatory factor analysis and multi-trait/-item matrix analyses. Internal consistency was assessed using Cronbach's α coefficient for item total correlations. We studied a total of 334 married or previously married adults with no cognitive impairment in the community settings. The eleven survey items were included in the final SOQ. Three factors were found: The first, "personal benefit", was devoted to the impact of one's sexual life and included four questions about the health-promoting effects and their recognition of healthiness, youth, and vitality as benefits of their sexual life. The second, "relational value", included four questions about sex as an expression of love and means of communication, and its effect on the improvement of their relationship with their spouse (partner). The third, "sexual endeavor", included three questions about the handling of sex-related problems, consulting with an expert, and sexual education. The questionnaire can briefly measure the sexual outlook of any married or previously married adult, regardless of disability.

Adult Perceptions of Healthy Pregnancy: A Focus-Group Study.

The fastest aging society with the lowest fertility rate can be buffered by support for healthy pregnancies using sociocultural approaches. We aimed to address adult perceptions of a healthy pregnancy and explored their needs and concerns about childbirth across the lifespan. We conducted a qualitative study using content analysis to investigate general perceptions of a healthy pregnancy after focus-group interviews with adult men and women. We interviewed 60 participants in nine group sessions of 5 to 8 people per group. Three major themes emerged that affect healthy pregnancies: Taking responsibility for a prepared pregnancy, factors that interfere with a healthy pregnancy, and improving strategies for a healthy pregnancy. For the first theme, the two main concerns were financial and parenthood preparation. Factors interfering with a healthy pregnancy had direct and indirect causes, considering personal, social, and cultural changes. Strategies for a healthy pregnancy included family and workplace support, systematic education, and governmental support for financial preparation and health screening. Participants averred that various kinds of support (financial, healthcare, and career) are needed for a healthy pregnancy and childbirth. This public awareness could promote better decisions toward healthy pregnancy with more sociocultural approaches in the various settings of home, school, and the workplace.

Public Reporting on the Quality Ratings of Nursing Homes in the Republic of Korea.

BACKGROUND: Quality ratings could provide vital information to help people in choosing a nursing home. PURPOSE: This study investigated factors aligned with quality ratings of nursing homes. METHODS: We employed a cross-sectional descriptive design to assess publicly available data on 1,354 nursing homes with 30 or more beds in the Republic of Korea. After excluding 289 nursing homes with no reported quality-evaluation ratings, we analyzed the 2015 data of 1,065 nursing homes. To prevent multicollinearity among independent variables, we carefully selected the final set of variables based on clinical and theoretical meaningfulness to direct nursing care. Quality, the ordinal outcome, was scored from 1 to 5 with a higher score indicating higher quality of the organization. We constructed a multivariate ordered logistic regression model. RESULTS: Higher quality ratings of nursing homes was significantly related to the number of unoccupied beds (OR=0.99, p=.024), registered nurses (RNs) (OR=1.30, p=.003), qualified care workers (OR=1.03, p=.011), cognitive-improvement programs (OR=1.05, p=.024), and other programs for residents' activities (OR=1.09, p<.001). CONCLUSION: The number of RNs had the strongest influence on the publicly reported quality rating, while the rating of qualified care workers demonstrated little effect and that of nursing assistants had no effect. The number of RNs could be used as a crucial indicator for high-quality homes; more resident-engaging programs also demonstrated better quality of nursing home care.

Perceptions of nurses on human papillomavirus vaccinations in the Republic of Korea.

BACKGROUND: In June 2016, the Republic of Korea included free human papillomavirus (HPV) vaccinations for all 12-year-old girls in its national immunization program. PURPOSE: This study investigated perceptions of nurses on HPV vaccination and their intent to vaccinate preteens at the best ages. METHODS: Recruited for the survey were 514 health teachers (181, 35.2%), public health nurses (168, 32.7%), and clinical nurses (165, 32.1%). Factor-analysis was conducted to validate the Vaccine-Hesitancy Scale for Korean nurses. Related variables associated with vaccine-acceptance were examined using the Kruskal-Wallis test and Spearman's rho coefficients, due to lack of normalization. RESULTS: Factor-analysis results showed that two factors of positive acceptance (7 items) and negative acceptance (3 items) accounted for 67.46% of the total variance, and explained 47.4% and 20.1%, respectively. Nurses who positively accepted HPV vaccine differed significantly in agreement to vaccinate girls or boys. For the proper vaccination age, a significant difference emerged between answers for girls and vaccine-acceptance scores, whereas no difference emerged between answers for boys and the scores. The vaccinated status of respondents significantly related to higher HPV vaccine acceptance, although age, religion, marital status, education, and working duration did not. CONCLUSIONS: This study showed that vaccine-acceptance levels reflect nurses' attitudes and opinions about HPV vaccination for girls and boys.

The role of telehealth counselling with mobile self-monitoring on blood pressure reduction among overseas Koreans with high blood pressure in Vietnam.

INTRODUCTION: Rapid globalization has produced a growing demand for the chronic care management of overseas populations living in medically underserved areas. This study investigated the utilization pattern of telehealth counselling among overseas Koreans with high blood pressure, and evaluated the relationships between mobile self-monitoring application and blood pressure reduction. METHODS: A global chronic management programme consisting of lifestyle modification and self-monitoring blood pressure was launched to provide a telehealth counselling service for Koreans with high blood pressure living in Vietnam from August 2016 to December 2017. During the first telehealth session, doctors educated patients on lifestyle modifications using a mobile self-monitoring application and checked the change of blood pressure in a follow-up telehealth visit. We examined utilization patterns and compared the blood pressure change among the mobile self-monitoring group versus the control group using Wilcoxon signed rank tests. RESULTS: A total of 234 patients with systolic blood pressure of more than 130 mmHg or diastolic blood pressure of more than 80 mmHg were registered, installed the mobile app and were provided with automated blood pressure devices with the telehealth counselling service by Korean doctors. A follow-up telehealth counselling session was provided at three months. Only 15% (36/234) received two or more telehealth counselling sessions. Significant differences were found in the mean change of systolic blood pressure at three months in the monitoring group and the non-monitoring group (-16.0 vs. -5.7, p = 0.008). DISCUSSION: In this unique telehealth study, a mobile self-monitoring application was associated with significantly reducing systolic blood pressure levels in three months. Encouraging patients via a mobile application that includes a self-monitoring function might have the potential for self-managing chronic diseases, especially in resource-limited environments.

Evaluation of a Telehealth Counseling Program for Expatriates.

Background: Health problems for expatriates are common due to their vulnerability to local infectious diseases, psychosocial problems, and chronic diseases, but many problems go largely unmet in this unique population. Introduction: Telehealth counseling was developed and tested for Korean expatriates. We explored the current status of using telehealth counseling systems and showed its feasibility and acceptability in three countries. Materials and Methods: This retrospective study was based on the "Development and demonstration of telehealth counseling program for overseas Koreans" project funded by the Korea Health Industry Development Institute. In this project, we established five Digital Healthcare Centers (DHCs): 3 in Vietnam and 1 each in Uzbekistan and Cambodia. We used data from October 2016 to September 2017; descriptive analysis and one-way ANOVA were used to present detailed information. Results: A total of 442 patients made an appointment for telehealth counseling services. Overall user satisfaction rates were 96.1%. Over two thirds of patients (302/442, 68.3%) completed one-time telehealth counseling. About 13% were referred to primary care, and 17 (3.8%) were referred to specialists or tertiary hospital. The most common diagnostic category was endocrine, nutritional, and metabolic diseases (14%), followed by diseases of the circulatory system (12.3%) for one-time visit patients. Discussion: Our telehealth counseling program for expatriates was feasible and acceptable in three countries. It also has the potential to minimize language barriers and the cost of healthcare usage. Conclusion: Further research for sustainable effective telehealth systems for expatriates will be needed.

Nurses' handoff and patient safety culture in perinatal care units: Nurses' handoff evaluation and perception of patient safety culture at delivery room and neonatal unit in South Korea.

AIM AND OBJECTIVES: To examine nursing handoff, identify causes of handoff errors, evaluate current methods of handoff and determine the factors associated with handoff evaluation in delivery rooms and neonatal units of hospitals in South Korea. BACKGROUND: Handoff is a critical communication process in clinical settings. Less attention has been paid to the handoff practice to assure safe perinatal care in hospitals. DESIGN: This is a cross-sectional descriptive study. METHODS: A total of 291 nurses participated in the study. They completed a set of self-reporting questionnaires containing five instruments that evaluated demographic data and current handoff strategies, experience of handoff error, causes of handoff error, perception of patient safety culture and handoff evaluation. The responses were analysed using descriptive statistics and stepwise regression modelling. RESULTS: Perception of patient safety culture was positively related to handoff evaluation, while experience and causes of handoff error were negatively related to handoff evaluation. A regression analysis showed that degree of cooperation among departments and units, reasonable communication and processes, and frequency of reported medical errors were positively related to handoff evaluation and the lack of documented guidelines or checklists was negatively associated with handoff evaluation. CONCLUSIONS: This study suggests that hospitals should develop a standardised handoff checklist according to documented guidelines, promote cooperation among hospital units and departments, enhance communication and clarify work processes to achieve safer care to create an affirmative culture that encourages reporting of errors to keep patients safe. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of standardising handoff process and systems, promoting communication and cooperating with each other to foster patient safety culture in perinatal care units.

Comparing the nurse staffing in Korean and U.S. nursing homes.

INTRODUCTION: The quality of nursing home care has been problematic in both the United States and South Korea; quality is limited to inadequate nurse staffing levels. This article addresses how South Korean nursing home education and training requirements, nurse staffing standards, and actual nurse staffing levels compare with those in the United States. METHODS: The study used secondary documents and data to compare the two countries. RESULTS: Korea has lower registered nurse and certified nursing assistant standards and actual staffing levels than the United States. In contrast, staffing standards and actual staffing levels for care workers who provide direct care to residents are higher in Korea than in the United States. CONCLUSIONS: Research is needed in Korea to establish an empirical basis for educational requirements, staffing standards, and staffing levels in nursing homes.

The effects of RN staffing hours on nursing home quality: a two-stage model.

OBJECTIVES/BACKGROUND: Based on structure-process-outcome approach, this study examined the association of registered nurse (RN) staffing hours and five quality indicators, including two process measures (catheter use and antipsychotic drug use) and three outcome measures (pressure ulcers, urinary tract infections, and weight loss). SETTING/PARTICIPANTS: We used data on resident assessments, RN staffing, organizational characteristics, and market factors to examine the quality of 195 nursing homes operating in a rural state of United States - Colorado. DESIGN/METHODS: Two-stage least squares regression models were performed to address the endogenous relationships between RN staffing and the outcome-related quality indicators, and ordinary least squares regression was used for the process-related ones. This analysis focused on the relationship of RN staffing to nursing home quality indicators, controlling for organizational characteristics, resources, resident casemix, and market factors with clustering to control for geographical differences. RESULTS: Higher RN hours were associated with fewer pressure ulcers, but RN hours were not related to the other quality indicators. CONCLUSIONS: The study finding shows the importance of understanding the role of 'nurse staffing' under nursing home care, as well as the significance of associated/contextual factors with nursing home quality even in a small rural state.

Assistive technology in medicaid home- and community-based waiver programs.

PURPOSE: As consensus emerges concerning the need to extend publicly funded home- and community-based services that support the independence of seniors, studies have reported the efficacy and cost effectiveness of assistive technology (AT). This article presents the latest available national AT expenditure and participation trends (1999-2002) for Medicaid 1915(c) waivers, the largest Medicaid home- and community-based service program. DESIGN AND METHODS: We collected annually reported Centers for Medicare and Medicaid Form 372 data from state officials for each waiver providing AT for the period from 1999 to 2002. Descriptive statistics examined trends in national participation and expenditures, interstate variations in participation and expenditures, and differences in provision between elderly persons and persons with developmental disabilities. RESULTS: Although we report a rise in the number of waivers providing AT, there has been much slower participant growth compared with the broader waiver program, and there is wide interstate variation in waiver AT provision. Not only do most waivers with AT serve persons with developmental disabilities, AT spending for that target group is almost twice that for aged or disabled waiver participants. IMPLICATIONS: This study highlights three policy concerns: first, the large interstate variations in AT provision in Medicaid waivers may signal access problems in some states; second, policy choices in some states may favor Medicaid spending on AT for the developmental disability population over that for the elderly population; and third, data limitations prevent a comparable state-by-state analysis of Medicare AT provision.

Shareholder value and the performance of a large nursing home chain.

OBJECTIVE: To analyze corporate governance arrangements and quality and financial performance outcomes among large multi-facility nursing home corporations (chains) that pursue stakeholder value (profit maximization) strategies. STUDY DESIGN: To establish a foundation of knowledge about the focal phenomenon and processes, we conducted an historical (1993-2005) case study of one of the largest chains (Sun Healthcare Inc.) that triangulated qualitative and quantitative data sources. DATA SOURCES: Two main sets of information were compared: (1) corporate sources including Sun's Security Exchange Commission (SEC) Form 10-K annual reports, industry financial reports, and the business press; and (2) external sources including, legal documents, press reports, and publicly available California facility cost reports and quality data. PRINCIPAL FINDINGS: Shareholder value was pursued at Sun through three inter-linked strategies: (1) rapid growth through debt-financed mergers; (2) labor cost constraint through low nurse staffing levels; and (3) a model of corporate governance that views sanctions for fraud and poor quality as a cost of business. CONCLUSIONS: Study findings and evidence from other large nursing home chains underscore calls from the Institute of Medicine and other bodies for extended oversight of the corporate governance and performance of large nursing home chains.

The collection and use of funds from civil money penalties and fines from nursing homes.

PURPOSE: This study examined federal and state civil money penalties and fines collected from nursing homes and how states used the collected funds. DESIGN AND METHODS: We used a telephone survey of state officials, Freedom of Information Act requests, state Web site searches, and stakeholder interviews to describe the funds collected, the availability and the use of funds, public information about penalties and fines, and the state allocation process and policies. RESULTS: In 2004, 43 states collected a total of $21 million from more than 3,000 federal and state penalties and fines. Forty-two states had $60.5 million in fund accounts from penalties and fines available in 2005, and 32 states spent $28 million on a wide range of projects. Fifteen states spent $17.9 million on survey and certification activities, 19 states spent $5.6 million on provider projects, 6 states spent $1.3 million on advocacy projects, and 12 states spent $2.7 million for other projects. Most states did not provide information to the public about issuing penalties and fines, have formal procedures to inform stakeholders and allocate funds, or involve stakeholder groups in the decision-making process. IMPLICATIONS: Funds from federal and state penalties and fines vary widely across states. These funds are a resource for improving the quality of nursing home care that needs more attention from policy makers and stakeholder groups.